Some people prefer supplemental plans to coordinate with their Medicare benefits. We will explain the different options available to you, in your location, so you can feel comfortable about your decision. We are licensed in 8 states (CT, FL, IN, OH, RI, SC, TN, WA) at this juncture and the rules can be different in each one.
There are a wide variety of supplemental plans. What people often like about them is that you pay a monthly premium on one of the plans and after that you might pay nothing! Nothing for your hospital visit, nothing for your doctor visit, nothing for the ambulance etc. etc. etc. however, they can be pricey. If you have a lot of medical issues a supplemental plan may make really good sense. If you are relatively healthy and only go to the doctor a couple of times of year they are more expensive, in my opinion. Besides having the supplemental plan you should also purchase a separate prescription drug plan for an additional cost. Some of the plans have foreign travel coverage but it is limited compared to some of the medicare advantage plans’ travel coverage.
They have also come out with newer plans that aren’t quite as comprehensive but are less expensive. Here we go again, with that familiar mantra, "Medicare is complicated!" We are here to uncomplicate things for you and give you options for the plans that are most comfortable to you. We are licensed with many different companies and in different states.
One of the drawbacks to supplemental plans is that if you are in the hospital and require an amount of time in a skilled nursing facility for rehabilitation, you must be in the hospital a minimum of 72 hours. Three full days of hospitalization before you are eligible to be referred into a skilled nursing facility. Whereas with the medicare advantage plans there is no minimum hospital stay to be eligible to be referred to a skilled nursing facility for rehabilitation. On the other hand when you go into a facility for rehabilitation you continue to pay after the first 20 days of coverage. With an Advantage plan you would pay $167+ per day after the first 20 days of copays
People who choose to purchase a Supplemental Plan should purchase a stand-alone Rx plan see more important information below. Again, there are many options to choose from and it helps to have the advice of knowledgeable people on your team. This area gets very tricky when it comes to some of the newer, expensive prescriptions. We often have to search many different companies’ plans to find the right fit for a person’s needs.
The prescription drug plans that are now available are changing on an annual basis until the year 2019. Congress a law in 2018 to get rid of the Medicare Rx "gap" ASAP. There are many plans available that cover the majority of prescriptions that are normally used by senior citizens. Of course, there are other circumstances where new drugs are coming out or the medication is extremely expensive and they may not be covered on the plan’s formulary. However, once you are in a plan you can ask for an “exception” to that particular prescription and your insurance company may or may not choose to reduce the tier, which causes the cost to be lowered. I repeat, “Medicare is complicated”. We often have to research to find a company that will cover some particular medications because the companies vary in what they will and will not cover. We at Hourglass are willing to put in that extra step on your behalf.
If you choose not to participate in the available Rx plans at the time you are eligible to purchase your Medicare part B, you may pay a lifetime penalty once you do sign up for a plan later. I have had clients who were not needing any prescriptions at the time they got the Medicare part B, so they assumed they could go without purchasing a Medicare prescription drug plan. As they matured they needed to get prescriptions and because they had not purchased it when they were first eligible they ended up having to pay a lifetime penalty of 1% per month of the average cost of a Medicare prescription plan. And since they had gone several years without a prescription drug plan it ended up being $13 or $14 a month extra. The reason for this is because insurance is what you purchase in case you need it. Everybody jumps into the pool when they’re healthy so that if they get sick they have coverage available. It works the same way with your home insurance and your car insurance. You cannot buy car insurance after you have already gotten in an accident, and you shouldn’t wait until you’re sick to buy health insurance. I know that buying health insurance without understanding became a law under President Obama, but then it is no longer true insurance, it’s more of an entitlement. And financially that does not work for the companies who have to cover the medical expenses.
Some people prefer supplemental medicare advantage plans to coordinate with their Medicare benefits. We will explain the different options available to you, in your location, so you can feel comfortable about your decision. We are licensed in 8 states at this juncture and the rules can be different in each one.
I personally prefer the advantage plans in most cases. I have been working with advantage plans since 2006. What I like about them is that you usually have a smaller premium, and then co-pays similar to what you had before you turned 65. There is usually no deductible for the medical care, the plan usually includes prescription drugs, which may or may not have a deductible and you can often buy optional services like dental plans. Silver Sneakers is now a benefit in almost all of the advantage plans that I work with. Some of the newer plans even include dental plans and hearing aid coverage in a zero-premium option. Of course that would be choosing to use an HMO, meaning you must use doctors who are in the network and you may be required to get a referral from your primary care physician to see a specialist. Again there are many plans and companies to choose from.
We at Hourglass Insurance Services are here to help you. We can make your Medicare enrollment experience pleasant and comfortable. We are also available after the last to help you each year going forward. We offer annual meetings to go over any changes that occur to your plan.
Health insurance has become a nightmare in the past 4 1/2 years. The prices have skyrocketed and I do not know anyone who has not been affected by the results. Some of the “pros” of the Affordable Care Act have been:
All preventative is covered by “no money out-of-pocket”. (However, for instance, if you are going in for a colonoscopy and they find an issue, then that procedure is now curative rather than preventative. That means you will have to pay your co-pay or coinsurance for that procedure. As long as your test results come back normal the preventative procedure is “no money out-of-pocket.” This scenario is true of all insurance, whether it is individually purchased or purchased through the state health care website.)
There are no longer health underwriting issues to deal with. As long as you purchase insurance during the open enrollment period or under a special enrollment period it does not matter if you have past or current medical issues. You do not pay any more for insurance than somebody who is perfectly healthy at your age. Gender is no longer a premium factor, in the past men were cheaper to insure than women up until the age of 50/55. Then women became cheaper to ensure.
The major drawback or “con” of the Affordable Care Act is that it is mandatory to purchase insurance. Recently President Trump rescinded that part of the law, so next year there will no longer be penalties if you do not purchase individual health insurance as of January 2019.
Another negative, in my opinion, of the Affordable Care Act, is that many health benefits were made mandatory for the insurance companies to cover. When these benefits were made mandatory for all insurance companies to offer it greatly increased the cost of providing health care. The companies have had to make a lot of changes to be compliant.
The drawback of this is that health insurance is no longer true “insurance”. You cannot legally drive a car without having automobile insurance in most states, however, you cannot purchase automobile insurance after you have had an accident and expect that those accident damages will be covered. In the same token, if you do not have fire insurance in place on your house, you cannot after the fact purchase fire insurance to pay for the damages caused by fire. It is simple logic.
The way all true insurance works is that everybody jumps into the “pool” before they have a need so that when they have a need there is money state-regulated healthcare set aside to cover it.
Another problem with Fed/State regulated healthcare occurs when people choose to purchase the insurance with subsidies. You must estimate what you are going to earn the year before you earn it. If you are in a job where you get a paycheck every week and your hours are stable, then that is probably not a big issue. But for the majority of people who use the subsidies, they are small business owners who have no clue what they are going to be earning the following year. What happens in that scenario is that you may end up earning several thousand dollars more than you thought you were going to earn, but you reported what you anticipated based on your history, so you got this nice big fat subsidy to where your premium was very, very low. After you do your taxes for that year and Access Health in CT is notified of the increase in income, they come back and bill you for the money that they gave you in excess of what you should have gotten based on your true income rather than your estimated income. I have had clients who had to pay $3000, $5000 or more.
Another issue with purchasing insurance through Access Health Connecticut with subsidies is that if you are 55 or older and they have to pay a lot of money out on your behalf for medical issues, at your passing they pull what they paid out on your behalf out of your estate.
You may, however, purchase health insurance through Access Health Connecticut without subsidies and then the 2 scenarios directly above do not apply. I have helped almost all of my clients use AHCT without subsidies this past year, beginning January 2018, because it saved them literally hundreds of dollars a month. In order to do this, I had to take a cut in commissions, but I would not be able to sleep at night if I didn’t offer this option. I get paid $10 a month per person up to a maximum of 2 people with ConnectiCare and $5 with Anthem Blue Cross and Blue Shield a month per person, Max 2 on a policy before I was getting $16 a month per person. But it would cost my clients $200, $300 or more a month. This is why I ask everyone to please refer me to your friends because that is the only way I can make up this loss in commissions. Not many agents are willing to work with Access Health Connecticut because of these cuts in commissions. But I am very dedicated to my clientele and I still go through the process of getting recertified every year so that I can help my clients if they ever have an issue. I am their advocate when it comes to their health insurance. I even got recertified last year (2017) when Access Health was not paying any commissions at all to agents. Money is not my motivator. I truly believe this healthcare nightmare is going to turn around and these people will stay loyal to me because I have been there with them through the trenches.
There are multiple ways you can purchase individual health insurance, from a privately owned company, i.e. ConnectiCare, Anthem Blue Cross and Blue Shield, United Healthcare, who are the major players in Connecticut. You can purchase ConnectiCare or Anthem Blue Cross and Blue Shield through Access Health Connecticut. United healthcare dropped out of Access Health Connecticut over a year ago. You can also purchase some ERISA Based Plans if you are a business owner or work for a small business owner. Remember each state is different. Most of my clients are in CT. When my client move, I often get licensed in their new state so I can keep them! <3
You can only purchase individual health insurance during an open enrollment period or if you have a special enrollment period. For instance, you just moved to the area, you recently lost insurance through a divorce or you got married, changing jobs, getting laid off, etc.
Each state has different insurance companies, and we are licensed in 8 states.
If you have any questions please call the office, we are here for you. 860-464-0121
We can also help companies put in place group health insurance for their employees. The Affordable Care Act also put a big burden on employers who own businesses of 50 or more employees. It also is costly to get health insurance for groups with less than 50 employees. People who own businesses who have less than 50 employees, please send your employees to us, we can help them get individual insurance even though they work for your company. See the information above regarding individual health insurance.
IF YOU ARE A HUGE COMPANY AND YOU ARE MAKING REALLY GOOD MONEY I WOULD LOVE TO HELP YOU!
It is very difficult to come up with a list of frequently asked questions because there are literally hundreds of them and each state has different rules and then each plan has different rules on top of that.
I have answered many questions in the sections I have written above.
IF YOU HAVE A QUESTION CALL US AT 860-464-0121. WE ARE HAPPY TO HELP.
IF WE ARE IN THE OFFICE, WE ANSWER OUR PHONES!